Peripheral Vascular Disease

Question 1

PVD =

Answer 1

Presence of systemic atherosclerosis in arteries distal to the aortic arch

Question 2

Risk Factors

Answer 2

Smoking
Male
DM
HTN/Ischemic heart dz
Hyperlipidemia
>60 yo

Question 3

Symptoms

Answer 3

Intermittent claudication
Asymptomatic (90%)
Non-healing ulcers on the leg
Cold feet/legs
Dependent rubor

Question 4

PE

Answer 4

Absent or diminished pulses
Abnormal skin color (dependent rubor)
Poor hair growth
Cool skin
Femoral artery bruit

Question 5

DD

Answer 5

Spinal stenosis
Baker cyst
Chronic compartment syndrome
Foot arthritis
Nerve root compression
Restless leg syndrome
Muscle/tendon strains
Peripheral neuropathy

Question 6

Labs

Dx Tests

Answer 6

CBC
Fasting Glucose or Hg A1C
Fasting Lipids
Serum Creat
UA

Ankle/Brachial Index

Question 7

Drug Tx

Answer 7

Antiplatelet therapy
Aspirin
Clopidogrel (Plavix)
Ticlopidine (Ticlid)

Phosphodiesterase Inhibitors
Cilostazol (Pletal)
Pentoxifylline (Trental)

Question 8

Exercise Stress Test

Answer 8

PVD is a marker for CAD

Need to obtain exercise stress test before allowing vigorous exercise

Question 9

Exercise Management

Intermittent Walking Technique

Answer 9

Walk until moderate to near maximal Claudication pain.
Rest briefly at sever claudication symptoms.
Rest in sitting or standing position.
Restart walking when claudication symptoms are tolerable.

Question 10

Exercise Management

Timed Walking

Answer 10

Start: 3-5 times a week for 30 minutes per time.
Increase by 5 minutes until 50 minute sessions are tolerated.
Continue program for at least 6 months.

Question 11

S&S of Acute Limb Ischemia

5 P’s

Answer 11

Pain 
Pulselessness
Pallor
Parasthesia
Paralysis

Question 12

Surgical Intervention Indications

Answer 12

Failed maximal medical therapy
Severe symptoms significantly reducing life quality.
Limb threatening ischemia
Rest pain
Non-healing wounds
Gangrene

Question 13

Surgical Procedures

Answer 13

Angioplasty (with or without stent placement)
Arterial Bypass
Intra-arterial Directed Thrombolysis

Question 14

Recommendations

Answer 14

Exercise increases walking time in pts with claudication
ASA reduces risk of serious vascular events
Most reliable physical findings: absent pedal pulse, femoral artery bruit, abnormal skin color, cool skin temp
Pts w/PVD and high chol should be tx’d with diet modifications and lipid lowering agents as needed
Pursue aggressive BP reduction
Duplex ultrasonography, MRA, and angiography are indicated for determining lesion localization and are best used when invasive intervention is a possibility